地高辛注射液治疗急性心力衰竭合并快速心房颤动的疗效分析  

Efficacy of digoxin injection in treatment of acute heart failure combined with rapid atrial fibrillation

作　　者：张永伟 李雅迪 梁海青[1] 张云强[1] 宋昱[1] Zhang Yongwei;Li Yadi;Liang Haiqing;Zhang Yunqiang;Song Yu(Intensive Care Unit,TEDA International Cardiovascular Hospital/Clinical School of Cardiovascular Diseases of Tianjin Medical University,Tianjin 300457,China)

机构地区：[1]天津医科大学心血管病临床学院、泰达国际心血管病医院心血管内科重症监护病房,300457 [2]重庆医科大学附属第一医院感染科

出　　处：《中华老年心脑血管病杂志》2024年第4期372-376,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家重点研发计划项目(2017YFC0111005);天津市医学重点学科项目(TJYXZDXK-020A)。

摘　　要：目的探讨地高辛注射液治疗急性心力衰竭合并快速心房颤动的疗效分析。方法选取2021年1月至2022年12月于泰达国际心血管病医院心血管内科重症监护病房就诊的急性心力衰竭患者956例,根据相关诊断和药物治疗方案从中筛选出合并快速心房颤动患者89例,分为地高辛注射液组47例,西地兰组42例。比较2组心率、左心室射血分数、左心室舒张末期容积、左心室收缩末期容积、血清肌酐、24 h尿量、可溶性生长刺激表达基因2蛋白(sST2)、白细胞介素6(IL-6)、N末端B型钠尿肽前体(NT-proBNP)差异,并随访患者出院后3个月内主要不良心血管事件(MACE)发生率,用logistic回归分析发生MACE的影响因素,用ROC曲线分析sST2、IL-6、NT-proBNP及三者联合预测MACE的价值。结果地高辛注射液组治疗3 d后有效率显著高于西地兰组(P<0.05)。地高辛注射液组治疗2 h、6 h心率显著低于西地兰组(P<0.05)。2组治疗后sST2、IL-6、NT-proBNP水平低于治疗前,地高辛注射液组治疗后sST2、IL-6、NT-proBNP水平低于西地兰组(P<0.05,P<0.01)。sST2、IL-6、NT-proBNP指标可作为急性心力衰竭合并快速心房颤动患者发生MACE的独立预测因子(OR=1.031,95%CI:1.009~1.069;OR=1.045,95%CI:1.000~1.092;OR=1.000,95%CI:1.000~1.001)。ROC曲线分析显示,sST2、IL-6、NT-proBNP联合预测的曲线下面积为0.908(95%CI:0.828~0.959)。结论应用地高辛注射液治疗急性心力衰竭合并快速心房颤动可有效改善胸闷、心悸症状,较西地兰起效更迅速,控制心率更佳,结合sST2、IL-6、NT-proBNP水平变化,预示更好的疗效。sST2、IL-6、NT-proBNP是急性心力衰竭合并快速心房颤动患者MACE的独立预测因子,三者联合对评估其预后MACE发生率有更高的预测价值。Objective To explore the efficacy of digoxin injection in the treatment of acute heart failure(HF)combined with rapid atrial fibrillation(AF).Methods A total of 956 acute HF patients admitted in our CCU between January 2021 and December 2022 were selected,and 89 patients complicated with rapid AF were screened from them according to the relevant diagnosis and medication regimen.Among them,47 cases were in the digoxin injection group and 42 cases were in the cedilanid group.Ventricular rate,left ventricular ejection fraction(LVEF),end-diastolic volume(LVEDV)and end-systolic volume(LVESV),serum creatinine,24-h urine volume(UV),and sST2,IL-6,and NT-proBNP levels were compared between the two groups.The incidence of MACE within 3 months after discharge was observed during the follow-up.Logistic regression analysis was used to analyze the influencing factors for MACE occurrence,and ROC curve analysis was employed to analyze the value of sST2,IL-6 and NT-proBNP alone and combined together in predicting MACE occurrence.Results The effective rate in 3 d after treatment was significantly higher in the digoxin injection group than the cedilanid group(P<0.05).The heart rate was obviously lower in the former group than the latter group at 2 and 6 h after treatment(P<0.05).The levels of sST2,IL-6 and NT-proBNP were decreased in both groups after treatment,with the levels in the digoxin injection group statistically lower than those in the cedilanid group(P<0.05,P<0.01).sST2,IL-6 and NT-proBNP were independent predictors for MACE occurrence in acute HF patients complicated with rapid AF(OR=1.031,95%CI:1.009-1.069;OR=1.045,95%CI:1.000-1.092;OR=1.000,95%CI:1.000-1.001).ROC curve analysis showed the AUC value of the combined 3 indicators in predicting MACE was 0.908(95%CI:0.828-0.959).Conclusion In the treatment of acute HF combined with rapid AF,digoxin injection can effectively improve the symptoms of chest tightness and palpitations,with advantages of rapid action and better control of heart rate when compared with cedilanid,a

关 键 词：地高辛 去乙酰毛花甙 心力衰竭 心房颤动 主要不良心血管事件 

分 类 号：R541[医药卫生—心血管疾病]